Ear Surgery, AKI and UTI (SA)

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Can you name the Ear Surgery and Medical urology (SA)

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This term refers to inflammation of the vertical and horizontal ear canal?
Otitis Interna refers to inflammation of the inner ear, caused by extension of infection into the _____ bone from otitis media?
Inflammation of the tympanic cavity and membrane is termed?
Which of the following statements regarding otitis externa predispositions is inaccurate?
a)Cocker spaniels are predisposed by excessive cerumin production and ear conformation b)allergic skin diseases and endocrinopathies predispose to otitis externa c)Neoplasia and foreign bodies can predispose to otitis externa d)excessive hair growth predisposes shar peis to otitis externa e)Increases in moisture, humidity and temperature may predispose to otitis externa. 
Which of the following is an indication to move to surgical management with otitis externa?
a)medical management has failed b)neoplasia is the cause c)the ear canals are stenotic d)in order to evaluate whether otitis media is occuring concurrently e)a, b and d f)a, b and c g)all of the above 
The extension of otitis externa may lead to otitis media and interna in canines and felines. What may also likely be a cause in cats?
Dogs may also get bacterial infections that lead to these conditions... 
Which of the following clinical signs/history items would you NOT associate with otitis externa?
a)hearing loss b)thickened, mineralized ear canals c)painful ear canals d)frequent swimming in history e)malodorous discharge 
Which of the following clinical signs would you only expect if otitis interna is present?
a)hearing loss b)stenotic ear canals c)head tilting or nystagmus d)Horner's syndrome e)pain opening the mouth and/or eating 
True or false: once ear disease has progressed to otitis media or interna, surgery is usually necessary?
Which of the following statements regarding Lateral Ear Canal resection is inaccurate?
a)owner satisfaction is generally low b)it is contraindicated by otitis media c)it can facilitate administration of topical agents d)it is indicated by small neoplastic lesions of the lateral canal or minimal hyperplasia e)all of the above are accurate statements 
Which of the following statements regarding vertical canal ablation is inaccurate?
a)otitis media is a contraindication b)it is indicated by malignant tumours in the vertical canal c)it is indicated by diseased vertical canals and normal horizontal canals, a rare state of affairs d)it is likely to fail if underlying dermatologic disease is not addressed e)all of the above are accurate 
Name a structure you must be cautious around when performing vertical canal ablation? (I accept two answers here... based on diagrams on slideshow)
What is a TECA? What is it paired with typically?
Which of the following is a contraindication of TECA-BO?
a)severe end-stage otitis externa b)cocker spaniel is the patient's breed c)neoplasia is confined to the external canal d)all of the above are actually indications for this procedure 
Name a complication of TECA-BO?
Cats under this age are most typically affected by nasopharyngeal polyps.
Conservative management of nasopharygeal polyps involves traction and administration of this drug?
10% recurrance. Exernal ear polyps use the same two things and have 50% recurrence. 
Violent head shaking or scratching due to otitis externa can cause cartilage fractures, and ruptures of branches of this artery, causing aural hematoma?
True or false: needle drainage is the recommended method of dealing with aural hematoma, aside from addressing the underlying cause?
True or false: correction of a aural hematoma may be corrected using various small slits, and/or buttons, and taping the dog's ear onto the top of its head for a time?
True or false: otitis externa or media may be signs of adenoma or adenocarcinoma of the ceruminous glands?
______ is defined as increased serum urea nitrogen and creatinine concentrations due to decreased GFR.
______ _____ describes the polysystemic clinical signs that present resulting from reduced renal function.
Renal Insufficiency occurs when approximately _ out of _ nephrons have ceased to function.
_ out of _.  
_____ ______ occurs when three quarters of all nephrons have ceased functioning.
Thus causing renal azotemia and uremic syndrome. 
What endocrine condition may be associated with azotemia?
An azotemic patient presents with the following signs. What is the likely origin of the azotemia?
The patient is a dog who presents in hypovolemic state, quite dehydrated. He is producing unusually small amounts of urine with a specific gravity over 1.030, and the BUN is more markedly elevated than the serum creatinine. 
An azotemic patient presents with the following clinical signs. Again, classify the azotemia?
The patient has extremely decreased or absent urine production. The USG on this patient will vary. 
Which of the following would you associate with a renal azotemia?
a)A high USG b)isosthenuria c)variable urine production d)low urine production only e)a and b f)b and c g) all of the above 
What is the newer preferred term for acute renal failure?
Associated with rapid loss of renal function, primary renal azotemia, and disruptions of fluid, electrolyte and acid base balances. 
True or false: the kidney receives about 1/4 of cardiac output, the majority of which flows to the medulla?
The renal cortex is susceptible to ____ insult moreso than the medulla, which is more vulnerable to _____ insult.
Think ethylene glycol, raisin toxicity in dogs, lillies in cats, NSAIDs, aminoglycosides, radiocontrast media, ACE inhibitors, vasodilators... 
Think hypotension, severe dehydration... 
Aside from toxic and ischemic etiologies of AKI, you might have infectious causes. Name one?
One could also have neoplastic (mainly lymphoma) or obstructive causes (in either the ureters or urethra). 
List these urine output levels in order of increasing injury: (Use the names in brackets.)
1-2 ml/kg/hr (normal), less than 0.08mL/kg/hr (anuria), over 2mL/kg/hr (polyuria), less than 0.5mL/kg/hr (oliguria) 
Note that when the tissue is repairing it will go in reverse order through these clinical signs of urine output level. 
True or false: polyuria tends to be a result of increased GFR?
What causes oliguria or anuria to occur? (Hint: not tubular dysfunction)
Within _-_ hours of hospitalization it is important to determine urine production for a likely renal case.
Give any single number of hours in the range and you get it. 
On biochemical profiling, azotemia involves increased creatinine, PO4-, K+ and _____, and a metabolic _____
Calcium oxalate crystals in urine sediment indicate this type of toxicity.
A urine bacterial culture would rule out this as a cause of acute renal injury.
Fill in the blanks: As kidneys filter less, there is less delivery of _____ ions to the macula densa, which causes systemic _______ after release of _____ intrarenally.
This is the pathogenesis of a common complication of acute kidney injury. This may ultimately result in retinal detachment or hemorrhage. 
This test may be indicated for patients iwth oliguria or anuria to assess bladder integrity and rule out leaks.
Unlike the test in the last question, excretory urograms and intravenous pyelograms are performed to rule out ureteral obstruction, not leaks. These are discouraged to prevent?
If both renal pelvises are enlarged you might suspect bilateral _____ or _____ _____
Lymphoma is suggested by diffusely thickened ______ on ultrasound.
You would expect hyperechoic, 'bright' kidneys as a result of this toxicity.
Which also produces calcium oxalate crystals in urine sediment... 
What is a major flaw of renal aspirates to evaluate for infiltrative disease?
This test is still indicated by concerns for neoplastic disease, or cases of ARF to diagnose or more likely give prognosis. It's not routine due to the risk of hemorrhage, damage to remnant kidney and the tendency to only identify end stage changes anyway. 
Which is not a concern you'd likely address in a renal patient?
a)fluid balance b)hyperkalemia c)hypophosphatemia d)nausea e)gastric acid excess 
Initial fluid plan should involve isotonic solution at 3x maintenance, with assessment every 6 hours or less. After hydration is achieved, fluids match _____ _____.
(Match and are dictated by...) 
If a patient is unable to excrete fluids at a rate equal to administration, and develops chemosis, weight gain or jiggly subcu tissues, this is termed?
As opposed to true ____, ____ ____ does not necessarily involve a drop in renal output... 
True or false: you should place a urinary catheter and a closed ocllection system to collect all naturally voided urine and calculate ins and outs?
With AKI cases. 
Name a centrally acting emetic you might recommend for nausea associated with AKI?
You may give sucralfate or proton pump inhibitors normally to lower gastric acid excess with AKI, but decrease dosing frequency of __ ____ ______ which are eliminated renally.
Which of the aforementioned gastric acid excess drugs would also be used as a phosphate binder?
The alternate choice would be aluminium hydroxide. 
Diets for azotemic patients should be _____-restricted.
To rule out a prerenal cause of suspected anuria or oliguria, you may give 20mL/kg isotonic fluid over 15 minutes and assess urinary response. This is termed what?
Caution with cardiovascular disease! Afterwards, assess hydration, BP and central venous pressure. If the patient remains dehydrated, try again, If not, you have confirmed ARF, and further fluid loading will cause overhydration. 
Approximately how many mL/kg/day should you give to an oliguric or anuric patient?
Within 5 mL either way will be accepted. 
Which is not characteristic of furosemide?
a)it is the diuretic of choice for increasing tubular flow rate b)you usually give it in two boluses followed by a 0.5-1mg/kg/hr IV infusion c)you discontinue use once urine production is re-established. d)The drug is given in 3 boluses 30-60 minutes apart. 
The max dose of _____, an osmotic diuretic, is 1.5g/kg. It is indicated by oliguria or imminent anuria, and contraindicated by volume overload or CV disease.
This agent is used mostly for leptospirosis, being an antihypertensive agent which prevents calcium influx in kidney cells?
Should be discontinued with bradycardia, caution with patients with high K+ 
Low doses of this drug improve renal blood flow, but are not proven to show improved outcome despite improved urine production.
Try when nothing else is working anyway. 
Which of the following etiologies for AKI is associated with the worst prognosis?
a) NSAID toxicity b)lepto patients c)ethylene glycol toxicity d)impossible to say 
If medical management fails for AKI, you may employ hemodialysis or PD. What is PD?
Removes metabolites and water by administering lots of dialysis solution into a body cavity. Indicated by Acute renal failure, toxicities, metabolic disorders. 
What is not a sign of acute renal failure?
a)creatinine over 884 umol/L b)urea over 35 nmol/L c)polyuria d)oliguria/anuria 
True or false: with peritoneal dialysis, you do hourly exchanges of small volumes for the first 24 hours, then increase to larger volumes q4-6 hours after stability?
The process usually ends when urine production resumes. 
Is UTI more common in dogs or cats?
True or false: UTI is less frequent in males?
What two properties of normal urine make voiding a natural defense mechanism?
Low ___, high ___ content 
Which of the following is NOT criteria for a complicated UTI?
a)UTI in a male b)presence of rinary catheter or stent c)concurrent systemic endocrine disorder d)2nd episode of UTI in 36 months e)all of these would constitute complicated UTI 
True or false: most UTIs are mixed infections?
You know Staph, yes and strept, and that enterococcus. Enterobacter and gross Pseudomonas. But do you recall? The most seen UTI bug of all?
It's not Klebsiella or Proteus. 
A _____ occurs with recurrent infection of the same bacteria, a ______ occurs when another bacteria has come in causing a second UTI.
Usually indicates inefficient amd treatment or prostatitis. 
Abnormal host defence in many cases. 
Which of the following is not generally associated with lower UTI?
a)pollakiuria (frequency increase) b)hematuria c)anuria d)stranguria e)periuria 
Name a contraindication for cystocentesis?
Usually good for differentiation contaminants from pathogens and selecting AMDs. 
How many times larger must a the colony count be to be to indicate UTI from catheterization urine culture, as opposed to cystocentesis?
Midstream collection is unreliable. 
True or false: sedation is typically required for catheterization of males?
This litter makes free-catch urine collection for cats a breeze compared to dogs, especially small dogs and males.
Which of the following dipstick analytic parameters would you consider accurate?
a)Leukocytes test b)pH c)nitrate test d)urobilinogen test e)specific gravity 
Pyuria refers to the presence of ___ ____ ___ in the urine.
True or false: the absence of pyuria rules out UTI?
Name one of two large spectrum antibiotic treatments you might choose to treat with during the 2-3 days you wait for culture results in UTIs?
Which of the following AMDs would you not use if you gram stained part of the urine sample and knew only that the bug was gram -ive?
a)TMS b)enrofloxacin c)ampicillin d)amoxicilline e)more than one of the above choices is incorrect 
If your urine culture and sensitivity came back and the bacteria was intermediate in response in vitro to your AMD choice, BUT you saw tissue response, what would you do?
a)discontinue first antibiotic choice and start an alternative b)continue the same choice and do urinalysis and culture after treatment is completed c)continue the same antibiotic until it is finished, don't repeat tests d)check compliance 
Complicated lower UTI treatment lasts over _ weeks, in comparison to 1-2 for uncomplicated.
Pyelonephritis takes over 8 weeks of AMDs. 
You should redo C and S testing with complicated UTIs
a)5 to 7 days after the start b)before stopping treatment c)7 days after you stop treatment d)all of the above 
True or false: When removing a U cath, it is advisible to culture the tip to screen for catheter associated UTI?

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Created Jan 21, 2014ReportNominate
Tags:ear, medical, surgery